Gender Confirming Surgeries for Trans Men

Listed are some of the surgeries that may be medically necessary or desired for trans men and gender-diverse people assigned female at birth. Some trans men undergo them all and some may undergo none or only some, either by choice or for health reasons. We strongly urge you to follow the links to additional resources for more comprehensive information about surgeries, care, risks and costs, and speak to your doctors regarding more complete information.

Without GCS sexual functioning, self-esteem, body image, socioeconomic adjustment, family life, relationships, psychological status and general life satisfaction are all negatively affected. This is supported by the numerous studies (Murad M., 2010, DeCuypere, 2006, Kuiper M. 1988, Gorton 2011, Clements-Nolle K., 2006), which also consistently show that access to GCS reduces suicidality by a factor of three to six (between 67 percent and 84 percent). Eighty percent of transgender people contemplate suicide, and 41 percent of transgender people attempt it. Lack of access to care is in fact likely to kill many transgender people. If this was a type of cancer that was killing 41 percent of the people who developed it, and it was possible to reduce the mortality rate by similar percentages, there wouldn’t be any argument happening.

It doesn’t even have to be life or death to be medically necessary, though. A herniated disk won’t kill you, but it will wreck your quality of life. Similarly, this is why every major medical, psychological, psychiatric, and therapist organization in the U.S. has issued statements supporting the medical necessity of GCS. The court system is increasingly acknowledging this, with five Circuit Courts having ruled that withholding transgender specific health care from prisoners is a violation of the 8th Amendment, because it is medically necessary.

Types of Surgeries

Chest Reconstruction Surgery

Bilateral mastectomy
The double incision technique is effective for individuals with a medium to large amount of breast tissue (cup size C and above, often also recommended for cup size B). In this method, large incisions are made horizontally across each breast, usually below the nipple.

Keyhole/Peri-areolar incision
The keyhole and peri-areolar techniques are effective for individuals with small amounts of breast tissue (cup size A or smaller is ideal; sometimes recommended by certain surgeons for cup size B). They are both done via incisions around the areola (the area of darker skin around the nipple), though the techniques differ slightly.

Hysterectomy and Oophorectomy

Hysterectomy
Removal of the uterus. There are three main ways in which the uterus can be removed from the body: either through an incision in the abdomen, vaginally through an incision in the top of the vagina (sometimes assisted laparoscopically through small incisions in the abdomen), or through a combination of tissue removal through small incisions in the abdomen as well as through the vagina.

salpingo-oophorectomy
For trans men, this procedure will usually be performed at the same time as your hysterectomy. Because the risk of ovarian cancer remains if the fallopian tubes are left behind, both the ovaries and fallopian tubes are usually removed during this procedure.

“Bottom” Surgery

Creation of a penis, usually accomplished (if accomplished at all) by one of two techniques:

Metoidioplasty
a procedure done on a clitoris that has been enlarged with the use of testosterone; it then resembles a cis man’s penis in appearance, though smaller than usual. The labia are joined together, with two prosthetic balls inserted within, to form a scrotum.

Phalloplasty
Phalloplasty involves the construction of a penis using donor skin from other areas of the body. Depending on the type of phalloplasty procedure, skin is typically taken from the abdomen, groin/leg, forearm, and/or side of the upper torso (latissimus dorsi area) and grafted onto the pubic area. Phalloplasty usually involves a urethral lengthening procedure so that the patient can urinate through the penis. Erections are usually achieved with either a malleable rod implanted permanently or inserted temporarily in the penis, or with an implanted pump device.

Codes Related to Gender Confirming Surgeries

These codes are related to diagnosis and billing, and normally patients don’t need to know these codes. They’re intended for insurance companies and health care providers to communicate with one another. But for trans people seeking services and trying to understand what medical coverage they may have for transition-related healthcare and surgeries, you may need to reference these codes when working with insurance companies to find out what care might be covered.

Diagnosis Codes

ICD-9-CM are a set of codes used by physicians, hospitals, and allied health workers to indicate diagnosis for all patient encounters. These are the codes that indicate that transition-related medical treatments are “medically necessary.” ICD-9 codes will be replaced by an equivalent ICD-10-CM code (or codes) when the United States transitions from ICD-9-CM to ICD-10-CM on October 1, 2015.

CPT and HCSPCS Codes

A Current Procedural Terminology (CPT) code is a five digit numeric code that is used to describe medical, surgical, radiology, laboratory, anesthesiology, and evaluation/management services of physicians, hospitals, and other health care providers. There are approximately 7,800 CPT codesranging from 00100 through 99499.

The Healthcare Common Procedure Coding System (HCPCS, often pronounced by its acronym as “hick picks”) is a set of health care procedure codes based on the American Medical Association’s Current Procedural Terminology (CPT).

Trans Men – Common Medical Procedural Codes

HCPCS Code

Description

J1070

Injection, testosterone cypionate, UP TO 100 MG

J1080

Injection, testosterone cypionate, 1 cc, 200 mg

J3120

Injection, testosterone ENANTHATE, UP TO 100 MG

J3130

Injection, testosterone ENANTHATE, UP TO 200 MG

J3140

Injection, testosterone SUSPENSION, UP TO 50 MG

J3150

Injection, testosterone PROPIONATE, UP TO 100 MG

CPT Codes

Description

55980

Intersex surgery; female to male

Also combinations of individual procedures billed separately, including but not limited to

19303

Mastectomy, simple, complete

19304

Mastectomy, subcutaneous

19350

nipple areolar reconstruction

53415

Urethroplasty, transpubic or perineal, 1-stage, for reconstruction or repair of prostatic or membranous urethra

53420

Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; first stage

53425

Urethroplasty, 2-stage reconstruction or repair of prostatic or membranous urethra; second stage

53430

Urethroplasty, reconstruction of female urethra

54400

Insertion of penile prosthesis; non-inflatable (semi-rigid)

54401

Insertion of penile prosthesis; inflatable (self-contained)

54405

Insertion of multi-component, inflatable penile prosthesis, including placement of pump, cylinders, and reservoir

54410

Removal and replacement of all component(s) of a multi-component, inflatable penile prosthesis at the same operative session

54411

Removal and replacement of all components of a multi-component inflatable penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue

54416

Removal and replacement of non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis at the same operative session

54417

Removal and replacement of a non-inflatable (semi-rigid) or inflatable (self-contained) penile prosthesis through an infected field at the same operative session, including irrigation and debridement of infected tissue